Tuesday, 19 December 2017

“If data can be re-identified with no more than SQL, there's no
"if" about a leak, and the "when" is history.”[Journalist Richard Chirgwin, Twitter
18 December 2017]

“But why are
medical records so attractive? Well, it turns out that there’s a metaphorical
holiday feast of enticing data served up in your average health record. Family
history, demographic data, insurance information, medications, etc. means
there’s enough information to completely steal an individual’s identity and
commit medication fraud, financial fraud, insurance fraud and a wide array of
other crimes. When this very private, unchangeable information gets into the
wrong hands, devastation can ensue.” [Robert
Lord writing in Forbes,
15 December 2017]

First the Australian general public were told that patient data was well protected and data breaches wouldn't happen as a result of government's drive to collect, cross-match and retain as much information about each and every Australian citizen/permanent resident as possible.

We were all going to be safe once more in the arms of the Turnbull Government.

Now the cat is out of the bag, because that billion-line 30 year's worth of personal health information about est. 3 million people just won't stay in the back of the ministerial cupboard where Greg Hunt shoved it.

One in ten Australians'
private health records have been unwittingly exposed by the Department of
Health in an embarrassing blunder that includes potentially exposing if someone
is on HIV medication, whether mothers have had terminations, or if mentally unwell
people are seeing psychologists.

A report, published on
Monday by Dr Chris Culnane, Dr Benjamin Rubinstein and Dr Vanessa Teague from
the University of Melbourne's School of Computing and Information Systems,
outlines how de-identified historical health data from the Australian Medicare
Benefits Scheme (MBS) and the Pharmaceutical Benefits Scheme (PBS) released to
the public in August 2016 can be re-identified using known information about
the person to find their record.

The study reveals unique
patient records matching the online public information of seven prominent
Australians, including three (former or current) MPs and an AFL footballer.
While a unique match may not always be accurate, Dr Rubinstein said there was
the possibility to improve confidence by cross-referencing other data.

"Because only 10
per cent of Australians are included in the sample data, there can be a
coincidental resemblance to someone who isn't included," he said.

"We can improve
confidence by cross-referencing with a second dataset of population-wide
billing frequencies. We can also examine uniqueness according to the
characteristics of commercial datasets we know of, such as bank billing
data."…….

Privacy analyst and
Lockstep consultant Stephen Wilson said the breach damaged public confidence in
health policy makers and data custodians.

"It's a huge breach
of trust," he said.

"Promises of
'de-identification' and 'anonymisation' made by health officials, and ABS too
in connection with census data releases, have been shown to be erroneous.

"The ability to
re-identify patients from this sort of public release is frankly, in my view,
catastrophic. Real dangers are posed to patients with socially difficult
conditions.

"It beggars belief
that any official would promise 'anonymity' any more. These promises cannot be
kept."

"In this case,
clearly more work needs to be done to protect individuals' identities,' he
said. "My hope is that the government embraces responsible research like
this and strives to improve confidentiality rather than penalise those seeking
to report deficiencies such as this."

The federal Department
of Health was notified about the issue December last year.

"The Department of
Health takes this matter very seriously and had already referred this to the
Privacy Commissioner," a Department of Health spokesperson told Fairfax
Media......

Meanwhile, the Office of
the Australian Information Commissioner, which houses Australia's privacy
commissioner, said it was investigating the publication of the datasets.

"The investigation
was opened under section 40(2) of the Australian Privacy Act 1988 (Privacy Act)
in late September 2016 when the Department of Health notified the OAIC that the
datasets were potentially vulnerable to re-identification," a spokesperson
said.

"Given the
investigation into the Medicare Benefits Scheme (MBS) and Pharmaceutical
Benefits Scheme (PBS) datasets is ongoing, we are unable to comment on it
further at this time.

However, the
commissioner will make a public statement at the conclusion of the
investigation."

The OAIC said it
continued to work with Australian government agencies to enhance privacy
protection in published datasets.....

Friday, 24 November 2017

The Department of Human Services flagged the illegal sale of Medicare details on the dark web almost a fortnight before the illicit trade was exposed in a bombshell media report, The New Daily can exclusively reveal.

Internal emails, obtained under freedom of information laws, reveal that department officials discussed the security issue as early as June 22 – nearly two weeks before revelations that Medicare numbers were being sold online.

On July 4, The Guardian revealed that a dark web vendor was advertising the sale of any Australian’s Medicare number for the bitcoin equivalent of just $22 after exploiting a government system vulnerability.

In the wake of the revelations, Human Services Minister Alan Tudge said that he and his department had only learned of the illicit trade when contacted by a Guardian journalist on July 3.

However, high-priority correspondence within DHS shows that senior officials discussed the trade on the dark net, which is only accessible through a customised browser, nearly two weeks before it made the news.

On June 22, Rhonda Morris, national manager for serious non-compliance, raised the issue with Kate Buggy, national manager for internal fraud control and investigations, and Mark Withnell, general manager of business integrity, as well as several unnamed officials.

In a later email on July 3, Mr Withnell apparently connected The Guardian’s inquiries to the department’s earlier discussions on the issue, writing to colleagues: “This is the one I was mentioning last week.”

It is unclear exactly what DHS knew about the sale of Medicare details on the dark web prior to July’s media report.

Citing exemptions related to law enforcement and criminal investigations, the department redacted most of the content of the emails released to The New Daily.

It refused to release numerous other related emails entirely.

A DHS spokesman denied the department had knowledge of a specific breach in June and said its internal discussions had only related to general matters……

In September, DHS told the Senate that as many as 165 people may have had their Medicare numbers sold to unknown parties, although there had been no unauthorised access of any Australian’s health records.

Last month, a seperate review commissioned by the department recommended beefing up the authentication procedures required to access the online database used by healthcare professionals.

Although the AFP is continuing to investigate the source of the breach, the government has said it was likely the result of “traditional criminal activity” rather than a cyber attack.

In February, DHS was embroiled in controversy after it released the personal information of a Centrelink recipient to a journalist in order to diffuse claims she made in the media.

Thursday, 10 August 2017

State and territory health ministers say hospital treatments and services will suffer under a Commonwealth proposal to withhold budgeted funds and reduce spending.

Federal Health Minister Greg Hunt has drafted a directive to the Independent Hospital Pricing Authority to review its public hospital funding method.

It would result in retrospective funds not being paid and reduced services in future, Queensland Health Minister Cameron Dick said in a joint statement issued after the COAG Health Council meeting in Brisbane on Friday.

Mr Hunt drew condemnation from Queensland, Victoria, Western Australia, South Australia, the Northern Territory and the ACT when he confirmed he would uphold the direction.

IHPA releases Consultation Paper on Pricing Framework for Australian Public Hospital Services 2018-19

The Independent Hospital Pricing Authority (IHPA) today released its Consultation Paper on the Pricing Framework for Australian Public Hospital Services 2018-19. The consultation is open to the public until Thursday 17 August 2017.

The Pricing Framework for Australian Public Hospital Services 2018-19 outlines the major policy decisions which will underpin the National Efficient Price and National Efficient Cost Determinations for 2018-19.

This year IHPA will seek feedback regarding work that has been progressed on pricing and funding for safety and quality as well as canvassing options to enable new and innovative approaches to value based or preventative health care models.

The Chair of the Pricing Authority, Shane Solomon said, “IHPA has continued to work closely with the jurisdictions, clinicians and other stakeholders to make significant progress on the implementation of national reforms to incorporate safety and quality into the pricing and funding of public hospitals in Australia.

“A range of factors must now be considered including risk adjustment and how the approach can be embedded as part of broader system change.

“The success of a safety and quality pricing and funding mechanism is dependent on national, state, and local health systems working together to support the implementation of a model and ensure that it is working to improve safety and quality across all services,” he said.

“The Consultation Paper is an important opportunity for stakeholders to engage with IHPA on the approach to pricing and funding for safety and quality as well as the emergence of new innovative pricing models to help improve public hospital services across Australia. We strongly encourage all interested parties to provide feedback as part of this process,” concluded Mr Solomon.

The Consultation Paper on the Pricing Framework for Australian Public Hospital Services 2018-19 is available on the IHPA website.

Submissions should be emailed as an accessible Word document to submissions.ihpa@ihpa.gov.au or mailed to PO Box 483, Darlinghurst NSW 1300 by 5pm on Thursday 17 August 2017.

On 16 February 2017 IHPA received a Ministerial Direction from the Hon. Greg Hunt under section 226(1) of the National Health Reform Act 2011.

The Direction requires that IHPA undertake implementation of agreed recommendations of the COAG Health Council on pricing for safety and quality to give effect to:

nil funding for a public hospital episode including a sentinel event which occurs on or after 1 July 2017, applying to all relevant episodes of care (being admitted and other episodes) in hospitals where the services are funded on an activity basis and hospitals where services are block funded; and

an appropriate reduced funding level for all hospital acquired complications, in accordance with Option 3 of the draft Pricing Framework for Australian Public Hospital Services 2017-18, as existing on 30 November 2016, to reflect the additional cost of a hospital admission with a hospital acquired complication, to be applied across all public hospitals; and

undertake further public consultation to inform a future pricing and funding approach in relation to avoidable hospital readmissions, based on a set of definitions to be developed by the Australian Commission on Safety and Quality in Health Care.

IHPA will incorporate the requirements under this Direction into the final Pricing Framework for Australian Public Hospitals 2017-18 due to be published on the IHPA website in early March 2017.

IHPA will undertake further consultation as part of its annual consultation process on the draft Pricing Framework for Australian Public Hospitals 2018-19 due for publication in June 2017 and provide a report back to the COAG Health Council by 30 November 2017.

Note: This follows on from a Direction received on 29 August 2016 which required IHPA to provide advice to the COAG Health Council on options for pricing for safety and quality.

The government found itself facing heavy criticism this week over how it handles Australians’ personal information, after a Guardian investigation revealed a darknet trader was illegally selling the details of any Medicare card holder on request by “exploiting a vulnerability” in a government system.

The data had been for sale since at least October 2016, and the seller appears to have sold the Medicare details of at least 75 Australians…..

“What’s happening is the community is wrapping these attacks together and seeing them as a threat, and it adds to a perception that their data is not safe,” said Australia’s privacy commissioner, Timothy Pilgrim. “All the players need to work out a way to build up that trust.”

But why do these breaches keep happening? And is the government doing everything it can to stop them, and reassure the public when they do happen?

The most critical risk to Australians from the misuse of Medicare card data is one of identity fraud. A fake Medicare card with legitimate details can get a criminal a quarter of the way to an entire fake ID. This could then be used by organised crime groups in any number of ways, for example by leasing property or equipment. It could also be used to fraudulently obtain services from Medicare itself.

In this case, the darknet was the vehicle for this particular identity fraud scam. But it didn’t need to be, and it is likely similar, less-sophisticated scams are taking place right now.

Tudge has used an unusual line to explain the breach. He has said it was not a hack or cyber attack, but “traditional criminal activity”. What he’s edging around is that his department believe this was a case of an individual using a legitimate method to access Medicare data – but for an unauthorised and illegal purpose.

But contrary to Tudge’s assertion, access control is very much a matter of cybersecurity. And there are a lot of problems with the way Medicare card details can be obtained.

For instance more than 200,000 individual users can potentially look up Medicare card details through the department’s system. The department has declined to answer whether each access is logged, which could allow it to trace when a particular card was looked up. If those controls aren’t there, it’s unlikely the darkweb vendor selling this data will be found.

It doesn’t mean someone sitting in a doctor’s clinic has been supplying the data. A prospective patient could show up at a GP’s reception, pretending to be someone else, and just ask for that person’s Medicare card details. Guardian Australia has spoken with one employee at a medical practice who said people regularly asked for their card details to be supplied.

Identity fraud using Medicare cards is coming to be seen as a big problem in the government. The human services department acknowledged in February 2016 that there had been 1,500 “probable” cases of Medicare fraud, a jump from 269. The Australian reported that in 2014 the justice minister, Michael Keenan, set out to quantify the scale of Medicare card fraud taking place. A study found Medicare cards and driving licences were the mostly commonly used forms of ID for fraudsters.

The problem appears to be growing worse as those given credentials to access Medicare card details legitimately has increased – jumping 25% in the last financial year – and as organised crime groups grow more sophisticated in their methods.

Thursday, 1 June 2017

Along with making home-owning aged pensioners pay for their Centrelink/Vet Affairs pensions by way of a debt against the value of their houses, it appears as though funding private hospitals at the expense of public hospitals may be on the Liberal-Nationals-Murdoch-IPA Coalition wish list.A list voters never actually get to see unless the Liberal and National parties are re-elected to government - at which time its contents are usually presented to the electorate as fixed policy.

Here it is. Minister claims to 'rule out' hospital funding overhaul but taskforce continued to meet. You can't trust Turnbull with Medicare. pic.twitter.com/3THdSs3kkx

Health department bosses have described their radical proposal to remake hospital funding as "future gazing" after the Turnbull government declared it would never adopt the controversial policy.

The private health insurance rebate would be abolished, consumers would be charged more for extras cover and the states would be forced to find more money for public hospitals under the plan.

As revealed by Fairfax Media on Monday, the nation's most senior health bureaucrats – Department of Health Secretary Martin Bowles and his deputy Mark Cormack – are members of a secretive taskforce formed to develop the policy around a "Commonwealth Hospital Benefit" (CHB).

Health Minister Greg Hunt immediately ruled out adopting the policy.

"Not government policy. Won't be government policy. Will never be government policy," Mr Hunt said.

Mr Hunt said the taskforce – funded by the department but run by a private think tank called Global Access Partners – pre-dated his time in the portfolio and he had already told bureaucrats he was not interested: "I've rejected it once. If it ever comes forward, I'll reject it again."

Officials attended a GAP meeting that explored the proposal just four days after Mr Hunt apparently told them not to pursue the idea in March.

And Mr Cormack met with members of GAP as recently as May, two months after they say Mr Hunt ruled out the proposal…..

They insisted there was nothing secret about the taskforce even though it was never announced, never released anything publicly and branded its material – leaked to Fairfax Media – as "confidential".

Mr Bowles insisted the taskforce was fully independent – even though the government paid for it with a $55,000 contract…….

Under the plan, the Commonwealth would "pool" the approximately $20 billion it currently gives to public hospitals each year with the $3 billion it pays to private sector doctors and the $6 billion it spends on the rebate to help people pay their private health insurance premiums.

It would use the money to pay a standard benefit for services regardless of whether they are performed in a public or private hospital, or whether people choose to be treated as public or private patients.

While the Turnbull government struck a three-year hospital funding deal with the states last year, it has flagged it wants a more long-term, less ad-hoc agreement – and a CHB proposal could fit the bill. COAG is set to revisit the issue of hospital funding next year to set the course for a post-2020 agreement.

He told Senate Estimates yesterday it was his job as head of the department to look at the future of health funding.

He confirmed the department had entered into broad policy work on the proposal.

However, it emerged he did not put the $55,000 contract for the consultancy work to tender.

Mr Bowles said he gave the work to Mr Peter Fritz, the head of GAP, after they met in 2016 and told the Senate it was possible for him to award contracts for work costing less than $80,000 without a tender process.

Senator Watts probed Mr Bowles about connections between GAP and the Australian Health Research Centre which is funded by a number of large health insurers.

Members of the AHRC attended taskforce meetings, he revealed.

However, Private Healthcare Australia which represents insurers has raised major concerns about the plan.

“I’m genuinely stunned,’ Private Healthcare Australia chief Rachel David said when she was told the work had been paid for by taxpayers.

“It was a dramatic overhaul of the health system that totally changed the role of private health insurance, eliminated the difference between public and private hospitals and wold have put doctors on salaries,” she said.

“It would have been inflationary, there was no demand management,” she said.

Peter Fritz - who besides being GAP Chair &Group Managing Director of TCG Pty Ltdalsochairs a number of influential government and private enterprise boards-andCatherine Fritz-Kalish currently GAP’s Managing Director.

Its offices are at71 Balfour St, Chippendale NSW 2008 Australia.

GAP sees its participation inhealth public policy to date thus:

*The Australian National Consultative Committee on Health (formerly known as the Australian National Consultative Committee on e-Health) was established as a result of Global Access Partners’ 2004 Forum on ‘Better Health Care through Electronic Information’.

The ANCCH represents the major ICT industry players and other stakeholder groups. The Committee contributes to the debate around the public and private health agenda in Australia with a view to promote and realise better patient health outcomes through the application of changes to process, and the interaction of technology to improve efficiency, safety and productivity.

The group also provides a forum for public-private partnerships in order to promote improved execution and industry development.

The Committee raises issues of national importance, influences government policy and supports the interests of its members. Its four broad areas of interest are agency coordination, chronic disease management, connectivity and infrastructure, and change management.

The ANCCH initiatives in the area of health and wellbeing over the last seven years have ranged from discussions of national health policy to the problems of implementing an Australia-wide e-health infrastructure and the potential applications of genetic testing in drug therapy to the management and long term funding of chronic "lifestyle" diseases in an ageing Australian population.

* GAP Taskforce on Government Health Procurement (2015-2016) is a cross-sectoral multidisciplinary group established by Global Access Partners to analyse Australia’s public health procurement and offer practical proposals for reform (see final report). The Taskforce considered the impact of procurement processes on the age and reliability of medical equipment, service levels, innovation and competition. Its final report highlights some of the inefficiencies of current health government purchasing and calls for a more rational tendering process to reduce costs and waste in the system, while improving the quality and safety of care.

Monday, 22 May 2017

In its 2017-18 Budget the Turnbull Government announced it would commence the phased
re-introduction of Medicare Benefits Schedule rebates

indexation.Treasurer and Liberal MP for Cook Scott Morrison stated in his Budget Night speech that “We are lifting the
freeze on the indexation of the Medicare Benefits Schedule. We are also
reversing the removal of the bulk-billing incentive for diagnostic imaging and
pathology services and the increase in the PBS co-payment and related changes.”

It now appears that it was premature to expect that out-of-pocket expenses for a number of

radiology and diagnostic imaging services might be contained after the rebate freeze was lifted for these services in three years time.

The Medicare rebate thaw will not apply to 93 per cent of scans, including the X-rays, MRIs and ultrasounds used to diagnose some of the most common forms of cancer.

Health Minister Greg Hunt's staged four-year thaw has been widely welcomed by doctors' groups such as the Australian Medical Association and the Royal Australian College of GPs. Under the plan, indexation will gradually be reapplied to bulk-billing incentives, visits to the doctor and allied health services.

On budget night, the Turnbull government said the final stage of the thaw, due in July 2020, would lift the freeze on "targeted" radiology and diagnostic imaging services - the first indexation since 2004.

Prime Minister Turnbull puts pressure on the Senate to back the increase to the Medicare levy after the release of two new opinion polls. Vision courtesy Seven News Melbourne.

While mammograms and a number of CT scans will be indexed under the plan, X-rays, MRIs, PETs and ultrasounds for such common conditions as brain, lung, breast and ovarian cancer will not. The rebate on common scans for arthritis and nuclear medicine will also remain frozen. [my yellow highlighting]

As for the promised reversing of the increase in the Pharmaceutical Benefits Scheme (PBS), this is only the potential for a flow-on effect from other changes in the PBS and is in no way guaranteed to occur.

Wednesday, 9 November 2016

Labor’s Medicare Locals integrated health care scheme ceased operations on 30 June 2015 when the Abbott Government replaced it with the Primary Health Networks scheme.

The Abbott and Turnbull governments’ grand plan for further ‘reforming’ Medicare service delivery swam into view on News.com.auand othermedia platforms on 30 March 2016:

SEVEN MILLION people in the country with chronic diseases like diabetes, heart disease and cancer will have to enrol with a single medical practice under a revolution in GP care to be announced by the Prime Minister today.

Patients will get to choose the GP practice that will co-ordinate all of the medical, allied health and out-of-hospital services they need.

And those with multiple chronic illnesses will get a care plan individually tailored to meet their needs.

Instead of paying their doctor a fee for service every time they receive treatment for their chronic illness, the government will give doctors a quarterly lump sum payment to care for the patient.

A fee for service will still be paid when the patient sees the doctor for other illnesses such as the flu or broken bones or other acute illnesses.

And the performance of doctors will be checked by the government via a new information bank that will measure patient outcomes at a local level and highlight areas for improvement.

Malcolm Turnbull says enrolling patients in a single medical home will help keep people with chronic diseases out of hospital by giving them evidence-based treatment.

This it turns out was merely announcing stage one in the introduction of the Health Care Homes model, which in October 2016 saw Prime Minister Turnbull and Health Minister Ley officially announcing the selected regions, based on Primary Health Network boundaries, for Stage One implementation of Health Care Homes. These include: Perth North, Adelaide, Country South Australia, South Eastern Melbourne, Western Sydney, Tasmania, Nepean Blue Mountains, Northern Territory, Brisbane North, as well as Hunter, New England and Central Coast in New South Wales.

Therefore in NSW the scheme will be initially implemented in three primary health care networks which stretch from western Sydney through to the NSW-Qld border.

By 4 November 2016 this scheme had quietly morphed in right-wing political backrooms into this according to the Herald Sun:

THE nation’s sickest cancer patients and people with diabetes and other chronic illnesses will get a maximum of $1795 worth of GP care a year funded by Medicare under a revolution in the way doctors are paid.

And Medicare will fund just five extra visits to the doctor if these people need medical attention for issues aside from their chronic illness under the Turnbull Government’s Health Care Homes model.

Doctors were expressing deep concern about the adequacy of the payment levels that were released without consultation with medical groups on November 4.

“The modelling is concerning and potentially leaves the whole program at risk of falling over because of being underfunded from the beginning,” AMA vice president Dr Tony Bartone said.

The Health Care Homes policy is a signature government policy which it claims will solve the woes of the Medicare system by providing comprehensive care for one in five Australians who have a chronic illness, keep them out of hospital and save the health system money.

Patients will have to enrol with a single GP practice to get a new form of wrap around health care under the model but Doctors are worried they’ll get less money than they receive now to care for the sickest patients.

Currently doctors are paid on a fee for service model and get paid $37 by Medicare every time they see a patient for a standard 20 minute visit, they get paid more for longer visits.

There are no limits on how many times a patient can see a doctor and get a Medicare rebate.

Under the new model patients with the least complex chronic conditions will get $591 a year worth of GP care, those with a slightly higher level of complexity will get $1,267 worth of GP care and the most complex patients will receive $1795 worth of care.

The sickest 12 per cent of patients account for 40 per cent of Medicare benefits and on average they receive 51 services a year, Dr Seidel said.

The maximum funding under the government’s health care homes model is only enough to cover 48 GP visits a year, or less than one per week.

Dr Seidel says a patient with diabetes and an infected leg would need to visit the GP at least three times per week to get it dressed.

The RACGP had asked the government to provide doctors with an extra $300 per patient per year on top of existing funding to make the new Medicare model work.

The current funding suggests doctors will be receiving less than they currently get.

Dr Bartone said the Health Care Homes model was based on a long standing method of paying GPs for caring for war veterans.

So now we all have a slightly clearer picture of how multi-millionaire Malcolm Bligh Turnbull and his fellow travellers intend to further pervert Medicare’s aim of providing universal health care.

Those with a chronic or complex medical condition will be tied to one general practitioner or medical practice and be restricted as to how many times a year they can see their doctor. Bulk billing is not guaranteed if that is not the policy of the medical practice/GP with which they are enrolled and, if they require more than 48 standard GP visits a year they may possibly be forced to pay the full cost of any additional ‘chronic illness’ visits . As for any other type of illness or injury they might experience – only five extra GP visits a year will be covered by a Medicare rebate [See update below].

At the moment participation on the patient’s part is allegedly voluntary, however if they agree to enter the Health Care Homes scheme they are forced deeper into the Abbott and Turnbull Governments’ insecure national database and ongoing government data retention scheme.

According to the Australian Dept. of Health, enrolment of up to 65,000 patients begins in 2017 and implementation of services delivery begins on 1 July that same year and continues through to the end of stage one on 30 June 2019. During this initial stage, Health Care Homes services will be limited to Medicare-eligible patients with two or more complex or chronic conditions.

Ongoing evaluation and refinement of Health Care Homes is also promised which probably means that, like e-Health aka My Health, the scheme will cease to be opt-in and become opt-out - or possibly even mandatory.

The Turnbull Government intends to fund Stage One of Health Care Homes by redirecting $93 million in MBS funding between 2017-18 and 2018-19 and providing an additional $21.3 million over the next three years to establish the design principles, IT systems and provide the training needed to assist health care providers to transition to the new system.

Thus far, this new scheme appears to offer no enhanced or additional health services to the chronically ill or those with complex medical conditions - it presents as nothing more than another federal government cost-cutting measure wrapped up in a public relation bow.

Stay tuned for the next instalment in the ongoing saga, “The Murder of Medicare”.

UPDATE

Turnbull Government backs down on capping number of extra GP visits for illness or injury not related to patient's chronic or complex medical condition. However, all other Medicare limits impacting on health services delivery to chronically ill patients appear to remain.

The cap on doctor’s
visits was revealed on Friday when the government announced details of its
keystone Health Care Homes trial.

The trial will see
65,000 chronically ill patients in 200 GP practices enrol with a single GP
practice for all their health care.

The Health Department
revealed doctors would be given an annual budget of between $591 and $1795 a
year to care for these patients, a budget doctors say amounts to a pay cut.

And in a fact sheet the
Department of Health said:

“Enrolled patients can
still access fee-for-service billing for a small number (up to five) of
episodes of care not related to a patient’s chronic conditions”.

On Monday, in a tweet,
Health Minister Sussan Ley denied there was a cap of five visits.

“No limit to Medicare
fee for service under health care homes. 5 appts departmental guide only. Opt
in not capitation. Co-designed with docs!”

Mysteriously, and
without a new press statement, wording of the department’s fact sheet on Health
Care Homes was changed on Monday to remove the five visit rule:

“Enrolled patients can
still access fee-for service episodes of care not related to a patient’s
chronic condition”.

Yesterday Ms Ley tweeted
“Capped visits were never on the table”.

In response to an
inquiry a spokesman for Health Minister Sussan Ley said the Department of
Health said it had “changed its fact sheet on payment information”.

“The Department amended
it to make it clear that there is no hard cap or limit on the capability of GPs
to bill MBS services not related to an enrolled patient’s chronic conditions.
The Department says it had nominated five as a notional number for planning
purposes for these services and that it was based on clinical advice. The
number of fee-for-service episodes of care will not be capped or restricted and
will be monitored during stage one of Health Care Homes,” he said.

Tuesday, 30 August 2016

Health Minister Peter Dutton has predicted an overhaul of Medicare, saying spiralling costs will make the system ''unmanageable'' without change.

In an interview with Fairfax Media, Mr Dutton gave the strongest signal yet that the Abbott government may adopt a politically explosive proposal to charge a $6 fee to visit the doctor…..

Annual spending on Medicare climbed from $8.1 billion in 2002-03 to $17.8 billion, an increase of 120 per cent. Growth in Medicare spending was faster than growth in the total health budget of 104 per cent over the decade, and Pharmaceutical Benefits Schedule spending, which rose 79 per cent over the same period.

There are 2.3 million Australians who see their doctor more than 12 times a year and they are eating up forty one per cent (16 billion) of the Medicare budget.

These patients received on average $1,850 in non hospital Medicare payments.

NOW it is something to celebrate….

Liberal MP for Farrer and Australian Minister for Health and Aging, Sussan Ley, media release, 28 August 2016:

An extra 17 million GP services were bulk billed under the Coalition last year compared with Labor following another year of record Medicare investment by the Turnbull Government, as Bill Shorten’s Mediscare lies “crumble around him” and leave the credibility of his leadership in tatters.

Minister for Health and Aged Care Sussan Ley today revealed a record 123 million out of 145 million GP services were fully-funded by the Turnbull Government at no cost to patients through Medicare during 2015-16.

This saw GP bulk billing hit a historic high of 85.1 per cent under the Turnbull Government – up from 84.3 per cent in 2014-15 – and follows the Coalition’s record $7.1 billion investment in general practice via Medicare last year.

The number of Australians accessing Medicare-funded GP services was also up by nearly half-a-million to 20.9 million last year, while the average number of services and spend per GP patient grew to 6.9 and $344 respectively…..

Overall, the number of Medicare services increased to 384 million in 2015-16 – more than one million per day – at a total cost of $21,107,750,246 – an increase of nearly $1 billion on 2014-15 – with the overall Medicare bulk billing rate also increasing to 78.2 per cent in 2015-16 from 77.6 per cent the year before.

I suspect that a number of government MPs will be making appointments with their local chiropractor after repeating this spectacular backflip.

Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers.
[Adopted and proclaimed by United Nations General Assembly resolution 217 A (III) of 10 December 1948]

NSW North Coast

Australian Bureau of Meteorology

Moggy Musings

Hi! My name is Boy. I'm a male bi-coloured tabby cat. Ever since I discovered that Malcolm Turnbull's dogs were allowed to blog, I have been pestering Clarencegirl to allow me a small space on North Coast Voices.

A false flag musing: I have noticed one particular voice on Facebook which is Pollyanna-positive on the subject of the Port of Yamba becoming a designated cruise ship destination. What this gentleman doesn’t disclose is that, as a principal of Middle Star Pty Ltd, he could be thought to have a potential pecuniary interest due to the fact that this corporation (which has had an office in Grafton since 2012) provides consultancy services and tourismbusiness development services.

A religion & local government musing: On 11 October 2017 Clarence Valley Council has the Church of Jesus Christ Development Fund Inc in Sutherland Local Court No. 6 for a small claims hearing. It would appear that there may be a little issue in rendering unto Caesar. On 19 September 2017 an ordained minister of a religion (which was named by the Royal Commission into Institutional Responses to Child Sexual Abuse in relation to 40 instances of historical child sexual abuse on the NSW North Coast) read the Opening Prayer at Council’s ordinary monthly meeting. Earlier in the year an ordained minister (from a church network alleged to have supported an overseas orphanage closed because of child abuse claims in 2013) read the Opening Prayer and an ordained minister (belonging to yet another church network accused of ignoring child sexual abuse in the US and racism in South Africa) read the Opening Prayer at yet another ordinary monthly meeting. Nice one councillors - you are covering yourselves with glory!

An investigative musing: Newcastle Herald, 12 August 2017: The state’s corruption watchdog has been asked to investigate the finances of the Awabakal Aboriginal Local Land Council, less than 12 months after the troubled organisation was placed into administration by the state government. The Newcastle Herald understands accounting firm PKF Lawler made the decision to refer the land council to the Independent Commission Against Corruption after discovering a number of irregularities during an audit of its financial statements.The results of the audit were recently presented to a meeting of Awabakal members. Administrator Terry Lawler did not respond when contacted by the Herald and a PKF Lawler spokesperson said it was unable to comment on the matter. Given the intricate web of company relationships that existed with at least one former board member it is not outside the realms of possibility that, if ICAC accepts this referral, then United Land Councils Limited (registered New Zealand) and United First Peoples Syndications Pty Ltd(registered Australia) might be interviewed. North Coast Voices readers will remember that on 15 August 2015 representatives of these two companied gave evidence before NSW Legislative Council General Purpose Standing Committee No. 6 INQUIRY INTO CROWN LAND. This evidence included advocating for a Yamba mega port.

A Nationals musing: Word around the traps is that NSW Nats MP for Clarence Chris Gulaptis has been talking up the notion of cruise ships visiting the Clarence River estuary. Fair dinkum! That man can be guaranteed to run with any bad idea put to him. I'm sure one or more cruise ships moored in the main navigation channel on a regular basis for one, two or three days is something other regular river users will really welcome. *pause for appreciation of irony* The draft of the smallest of the smaller cruise vessels is 3 metres and it would only stay safely afloat in that channel. Even the Yamba-Iluka ferry has been known to get momentarily stuck in silt/sand from time to time in Yamba Bay and even a very small cruise ship wouldn't be able to safely enter and exit Iluka Bay. You can bet your bottom dollar operators of cruise lines would soon be calling for dredging at the approach to the river mouth - and you know how well that goes down with the local residents.

A local councils musing: Which Northern Rivers council is on a low-key NSW Office of Local Government watch list courtesy of feet dragging by a past general manager?

A serial pest musing: I'm sure the Clarence Valley was thrilled to find that a well-known fantasist is active once again in the wee small hours of the morning treading a well-worn path of accusations involving police, local business owners and others.

An investigative musing: Which NSW North Coast council is batting to have the longest running code of conduct complaint investigation on record?

A which bank? musing: Despite a net profit last year of $9,227 million the Commonwealth Bank still insists on paying below Centrelink deeming rates interest on money held in Pensioner Security Accounts. One local wag says he’s waiting for the first bill from the bank charging him for the privilege of keeping his pension dollars at that bank.

A Daily Examiner musing: Just when you thought this newspaper could sink no lower under News Corp management, it continues to give column space to Andrew Bolt.

A thought to ponder musing: In case of bushfire or flood - do you have an emergency evacuation plan for the family pet?

An adoption musing: Every week on the NSW North Coast a number of cats and dogs find themselves without a home. If you want to do your bit and give one bundle of joy a new family, contact Happy Paws on 0419 404 766 or your local council pound.